Best Value Prescribing in Leeds

The brand of your medication may be switched to a more cost-effective version for the NHS. In some cases, people are prescribed a branded medication, even though a cheaper generic or alternative brand is available.

Additionally, changing the form of the medication, such as switching from a capsule to a tablet, can be more cost effective. The drug and dose remain unchanged, only the form of the medication differs.

Oral nutritional supplements (ONS) are used to provide additional nutrients to people who are unable to meet their nutritional needs through food alone. They are commonly used to treat malnutrition and are often prescribed for patients with conditions such as:

• Short bowel syndrome
• Dysphagia
• Intractable malabsorption
• Inflammatory bowel disease
• Total gastrectomy
• Bowel fistulae
• Disease related malnutrition

People taking food supplement drinks may be changed to a different brand. In Leeds the brand ‘Aymes’ is recommended as it has similar ingredients to the other more expensive brands.

NHS in Leeds does not routinely provide gluten free foods on prescription because these items are now readily available. There’s more information provided here:

The NHS has asked doctors to stop or greatly reduce the prescribing of bath and shower preparations. This is because research has shown that the use of these products does not have any benefits. For more information:

In line with NHS England’s guidance on conditions for which over-the-counter items should not be routinely prescribed, Leeds does not support the routine prescribing of vitamin D (Colecalciferol, ergocalciferol) for maintenance or prophylaxis of vitamin D insufficiency. Your doctor may ask you to buy it over the counter. Read about Vitamin D here:

Your GP, nurse or pharmacist will not generally give you a prescription for over-the-counter medicines for a range of minor health concerns. Instead, over the counter medicines are available to buy in a pharmacy or supermarket in your local community. See here for further information:

NHS England has published a policy guidance for items which should not be routinely prescribed in primary care. These medicines may be:

• for which there are significant safety concerns
• for which there is a lack of robust evidence of clinical effectiveness
• that are clinically effective but not the most cost-effective intervention
  available.
• that are clinically effective but deemed a low priority for NHS funding.

Prescribers are advised that no new patients should be started on these items, that they should be deprescribed for current patients and that, where possible, suitable alternatives should be identified for patients.

The guidance can be read here: NHS England – Items which should not routinely be prescribed in primary care: policy guidance.

Structured Medicine Reviews (SMRs) are an evidence-based and comprehensive review of a patient’s medication, taking into consideration all aspects of their health.

Key components of a SMR:

• Shared decision-making principles – clinicians and patients work as equal partners
• Personalised approach – conversation being led by the patient’s individual needs, preferences and circumstances.
• Safety – consider the balance of benefit and risk of current treatment and starting new medicines
• Effectiveness – all medication must be effective, noting NHS guidance on certain exceptions to items that should not routinely be prescribed in primary care.”

A range of information materials to support patients having a structured medication review are available on the Health Innovation Network website.

Below is a video to help you understand the purpose of SMRs and how to get the most out of an appointment.

What is repeat prescribing?

Some medicines may be required to be taken on an ongoing basis to help manage your long-term condition. You can order your medicines on a regular basis without having to see a GP every time.

What can you expect from your NHS Repeat Prescribing system?

Your prescriber:

When your prescriber (e.g., GP, pharmacist or nurse) authorises that your medicine(s) can be repeated, they will set out how often you can have the medicines (e.g., monthly or every two months) and for how long (e.g., up to a year). After this time, you should receive a notification for a medication review to check how you are getting on with the medicines, if they are working for you and if you need to continue to take them.

Your community pharmacy (or dispensing doctor):

Once your prescription has been authorised, you can either collect it or it will be digitally transferred to your nominated community pharmacy. This is known as the electronic prescription service (EPS). If you receive your medicines from a dispensing practice, they will send the prescription directly to the dispensary. It will take the pharmacy or dispensary time (which could be a number of days) to then dispense your medicine(s) ready for you to collect.

What are your responsibilities to ensure you get your repeat medication safely?

• Please order your medicine(s) in plenty of time to allow the GP and pharmacy to check, authorise and dispense your medicine(s) BEFORE you run out.
• Please DO NOT over order medicines. Your GP practice can check the quantity of medicines that you have ordered. Over ordering is unsafe, costs more money and can result in medicine shortages. Only order what you need.
• Please check your medicines as soon as you receive them to ensure you have exactly what you expected.
• Please tell your pharmacist or GP if there are any medicines you are no longer taking, or if you are taking any new over-the-counter medicines or medicines prescribed from the hospital or privately.
• Please do not reorder any medicines that you have agreed to stop taking.
• Some medicines require regular monitoring/ medication reviews. This might be in the form of a regular blood test or more frequent medication reviews. If you need blood tests, please book your tests as often as is necessary. These tests are vital to ensure that the medicine is safe for you to have on repeat.
• PLEASE return all unused medicines to the pharmacy to be disposed of safely.

For further information regarding repeat prescribing please see: Repeat prescribing patient partnership agreement.